What is Medicare? Will It Cover All My Medical Bills? Q & A

Q.  I am a fifty-five year old man on disability for a traffic accident I was in about eight years ago. The doctors believe that I am not permanently disabled, though I still have problems walking without a cane. I lost my job and later my medical insurance because I could no longer afford the COBRA premiums. Do I qualify for Medicare benefits?

A. Probably not. The program was designed to meet the medical needs of people sixty-five years or older, though there are defined exceptions. Specifically, if you can show that you have been on social security disability for a period of 24 months or longer. Or have worked long enough in a federal, state, or local government job to be insured for Medicare. Or have a defined medical condition as discussed below.

About Medicare Generally

Medicare is a federal program that provides access to health insurance for Americans ages 65 or older and younger people with defined disabilities and conditions such as terminal renal disease.

Even if you did qualify by age or specific condition, Medicare on average would only cover about fifty-percent of health care costs.

The Basics of Medicare Coverage

Medicare is a defined benefit plan. It offers hospital care under what is called “Part A” and outpatient medical services, which is referred to as “Part B” of the plan.

Medicare also provides the option of going through an open-network of providers. This is called the single payer health plan and known as “Part C” which is where the federal government contributes to the enrollee’s private health coverage. Medicare “Part D” is designed to cover outpatient prescription drugs.

Qualifying For Medicare

To qualify for Medicare you must be 65 or older, be a U.S. citizen and/or have permanent legal residency in the United States for 5 years or more.  You will also have to establish that you or your spouse has paid taxes for a period of ten years.

If you are not 65 years or older and a US citizen, you may still qualify but you must establish that you have a defined disability by showing that you have been receiving social security disability insurance benefits.

There are some exceptions to the qualification process that may determine your eligibility. Specifically, you are suffering from a renal disease and have been on dialysis or in need of a kidney transplant or you can establish that you have ALS or Lou Gehrig’s disease.

Qualifying By Paying A Monthly Premium

People who are 65 or older or who are under 65 but eligible for Medicare hospital insurance will be able to enroll for Medicare medical insurance by paying a monthly premium.

Finally, you may also qualify if you are eligible to receive Railroad Retirement benefits but have not yet applied for or you worked in a Medicare covered position for the government for a period of years.

You should also see if you qualify for Medicaid which is a joint federal and state program based on level of income. You should know however poverty alone does not necessarily qualify someone for Medicaid. Each state has different eligibility and program criteria.

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For more information on Medicare you can visit the government website.


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